Are you a first-time pet owner? A long time pet owner? Taking care of your dog or cat can be overwhelming. The first step to keeping your pet healthy is to take them to a veterinarian when needed, but there are many other things you should do to raise and maintain a happy, healthy pet.
We’ve provided some resource guides below to guide you in your role as a pet owner. Read these guides to prepare yourself to provide the best care for your pet. Remember to call our office to set an appointment or checkup for your dog or cat.
Dental Care for Dogs and Cats
February is National Pet Dental Health Month, but dental care isn't just necessary in February. Dental disease is the most common health issue seen in companion animals. According to the American Veterinary Dental College, 80% of dogs and 70% of cats have some degree of periodontal disease by the age of 3 years! Periodontal disease doesn't just cause a foul or stinky mouth, but can aggravate heart, liver, and kidney issues, make it difficult to regulate chronic medical conditions, as well as causing unnecessary pain and discomfort. The bacteria and toxins released by untreated dental disease enter your pet's blood stream and can cause infections in various organ systems and make it difficult to treat common infections like Urinary Tract Infections, Upper Respiratory Infections, or skin infections.
Stages of Oral Health
Healthy Teeth and Gums
Healthy teeth should have minimal tartar and plaque buildup. The gums should be pink and firmly attached to the tooth surface. There should be no fractures, cracks, chips or holes (known as resorptive lesions in cats). Gums should not be receded or bleeding.
Stage 1 Periodontal Disease
Plaque and tarter build up is a visible yellowish film or caking on tooth surface. Gums may be slightly inflamed or reddish nearest the tooth. Gums may bleed easily when abraded. This stage also includes clinical Gingivitis. You may begin to notice a foul or strong odor to your pet's mouth. Bacteria on the tooth surface are destroying the tissue that connects the tooth to the gums at this point. If your pet has Gingivitis (severe inflammation of the gingiva or gums), you may notice a preference for chewing on one side of the mouth, not chewing kibble or less interest in hard treats or dental chews.
Stage 1 periodontal disease is often dismissed or overlooked delaying dental care. It is this stage where we can do the most preventative care to preserve your pet's teeth, reduce pain, and reduce strain on the internal organ systems.
Stage 2 Periodontal Disease
Stage 2 periodontal disease is also known as Early Periodontitis. It is at this stage we see receded gums, some exposure to the tooth structures below the gum line, "pockets" or loss of gingival attachment, and heavy tartar buildup. The gums are very red, tender and sometimes swollen. You may notice what appears to be a film or "goo" between the gums and the tooth. Pets with stage 2 periodontal disease often have a very foul odor to their breath, can be resentful of having their mouth handled or touched, or may show a definite preference for soft or moistened food.
In some breeds, most commonly small breeds with overcrowding of the teeth, it is at this stage in which loose teeth may become noticed by owners.
Stage 3 Periodontal Disease
Stage 3 periodontal disease is classified by a loss of 20-50% of the attachment between the gums and the tooth. We commonly see moderate gingival recession where the gum has pulled up from the tooth exposing large sections of the underlying structures and roots. While this may not noticeable when the tartar is present, it is once removed. We may see pus from areas around the heaviest tartar build up. Dental infections are very common in this stage of disease.
Your pet's mouth is painful at this point. Chronic dental pain can affect more than just eating and drinking and sometimes is noticed as a pet who is "irritable" or "just cranky".
Stage 4 Periodontal Disease
Stage 4 Periodontal Disease is very painful for your pet. There is extremely heavy buildup, pus around multiple teeth, very mobile teeth, gums that bleed easily and deep recession and pocketing. Your pet may have already lost multiple teeth by this stage. Deep infections in the jaw and nasal structures are very common from abscessed tooth roots. Pain from this stage of dental disease can cause decreased interest in eating, refusal to eat hard kibble or a sudden stop in eating, a lack of interest in toys, or behavioral changes.
By stage 4 dental disease, regular professional dental cleanings are vital to returning your pet to health. Extracting severely damaged, infected and loose teeth can be an aid to reducing dental disease and home care will be essential to maintaining a healthy mouth for your pet.
Toothbrushes: Not Just for People
Home care following a dental cleaning is essential to maintaining oral health for your pet. The American Veterinary Dental Society recommends brushing your pet's teeth daily in addition to twice yearly dental cleanings with your veterinarian. While this may seem daunting at first, with time and patience you can make brushing your pet's teeth a normal part of the daily routine. See How to Brush Your Pet's Teeth for our guide. You are also welcome to call our hospital to speak to a technician for even more tips.
Tooth Friendly Treats and Diet
The type of treats you give your pet can play a big role in his or her dental health. Tooth fractures are common dental injuries and are seen most often in dogs that chew on cage or crate doors, fences, cow hooves, rocks or hard toys. Fractures can also occur due to fighting or traumatic injury which is commonly seen in cats. Just as in people, broken teeth hurt! Avoid "treats" such as cow hooves and don't give your dog hard plastic toys.
Dental friendly treats include C.E.T Chews. These chews are available through your veterinarian and contain a special enzyme which provides a more effective means of removing plaque and buildup than ordinary biscuits. We also carry Hill's Prescription diet T/D and Royal Canin Dental. Two of the few products awarded the Veterinary Oral Health Council's Seal of Acceptance for helping to reduce both plaque and tartar buildup. These can be fed as a standard diet or used as a treat and both come in a regular (medium to large breed), small bites (small and toy breed) and feline formulas.
It is never too early to start your pet on the right path for a healthy mouth. The veterinarians and technicians at Orange Grove Animal Hospital are here to help. Call to schedule your pets Dental Health checkup today!
Heartworm Disease Information
Heartworms are a roundworm scientifically known as Dirofilaria immitis which is transmitted by mosquitoes and can infect more than 30 mammal species including dogs, cat and people. While dogs are considered the definitive (or preferred) host, cats, ferrets and wild mammals like coyotes can also be infected. Heartworm is found in all 50 states although traditionally highest rate of infection is seen within 150 miles of the Atlantic and Gulf Coasts and along the Mississippi River. While some arid areas of the country such as Arizona have lower rates of infection, we do have the vector (mosquitoes) and are seeing an increase in native dogs testing positive for heartworm.
The Heartworm Life Cycle
The adult female heartworm, living in the artery or right side of the infected mammal's heart, releases microfilariae (young heartworms) into the bloodstream. An adult mosquito bites the infected animal and ingests the microfilariae with its blood meal. Over the next 10 to 14 days the microfilariae mature into an infective larval stage. When the mosquito bites another mammal, the infected larvae leave the mosquito in the saliva and enter the new host. Over the next 6 months, the microfilariae mature into adult worms and make their way to the heart and lung arteries, where they repeat the cycle again.
Adult worms can live for up to 7 years in the host mammal, reproducing and sending more microfilariae into the blood stream.
Symptoms of Heartworm Disease
In our companion animals, the clinical signs of heartworm disease may not be seen in the early stages and can mimic a number of other diseases and conditions. In dogs, as the number of adult worms in the heart multiplies, you may notice a mild persistent, non-productive cough, exercise intolerance and fatigue, decreased appetite, weight loss, or lethargy. As these symptoms mimic other frequently seen diseases in Tucson, your veterinarian may include heartworm testing with other laboratory tests if your pet is not on consistent or currently on preventative.
In cats, clinical signs can be even more vague and non-specific. Symptoms of chronic disease can include, vomiting, gagging, difficult or rapid breathing, lethargy, coughing, panting, open-mouth breathing and weight loss. Heartworm Associated Respiratory Disease can often mimic asthma or allergic bronchitis. Cats may also exhibit acute signs including collapse, convulsions, blindness, heart rate and rhythm disruptions, syncope (fainting) or sudden death.
Routine, annual testing for the substance produced by the adult female heartworm, known as antigen testing, is the most effective method for detecting infection in dogs. Testing for the presence of microfilariae by reviewing blood smears is also used to detect early infection, the period before the adult heartworms has established residence in the arteries or heart and begun reproducing. In cats, we recommend antigen testing for the female adult heartworm and antibody testing for the male adult heartworm as cats can have male-only infections. Neither antigen, antibody nor microfilariae testing are accurate until about seven months after infection due to the development period for the adult form. False negatives by reviewing blood smears are also possible if the pet is given preventative medication inconsistently.
In addition to testing for heartworm disease, the test we commonly use here at Orange Grove Animal Hospital also tests for tick borne diseases such as Ehrlichiosis, known as Tick Fever and Lyme disease. Tick Fever is a common, life-threatening parasite carried by the tick native to our area, the Brown Dog Tick. We do not have the ticks that carry Lyme disease, Rocky Mountain Spotted Fever (Rickettsia sp) or Anaplasmosis. Tell your veterinarian if your dog has been out of Tucson and where he or she has been in the last year.
Treating Heartworm Disease
Treating heartworm disease is done through your veterinarian by giving a series of injections of an adulticide into a muscle. There is only 1 medication approved by the FDA for the treatment of heartworm disease in dogs. Any "holistic" or "herbal" treatments should be avoided as risk of life-threatening complications is high as these products have not been evaluated for safety or effectiveness.
Owners are then instructed to restrict activity to very short leash walks and cage rest for 1-2 months while the adult worms are processed by the dog's body. It is very important that owners follow activity restrictions to decrease the risk of partial or complete blockage of blood flow to the lungs by the dead worms. Dogs undergoing heartworm treatment will need to be isolated from other dogs to prevent secondary infections such as upper respiratory infections (Kennel Cough) as their immune systems are under compromise from the parasite and treatment.
Untreated heartworm disease will lead to death as the heart and lungs become filled with worms that block blood flow, reduce the heart's ability to contract and prevent the heart valves from opening and closing properly. This reduction in blood flow can also lead to blood clots in the lungs, liver or kidneys.
Treatment involves a hospital stay of 1-2 weeks, frequent rechecks to include xrays or ultrasound to evaluate if any permanent heart damage has occurred, and retesting to catch any new infections while the current infection is being treated.
Prevention: Safer & More Cost Effective
Prevention, even with yearly testing, is a fraction of the cost of treatment for heartworm disease. There are currently 6 medications approved by the FDA for prevention of Heartworm disease in dogs and cats which come in a number of formulations under several brand names. We recommend and carry Heartgard® Plus and Revolution®. We do not recommend any of the many "organic" or "holistic" products described on the internet or at feed stores as their safety and effectiveness has not been clinically evaluated and approved for use nor are they recommend by the American Veterinary Medical Association or the American Heartworm Society.
As Tucson has the vector (mosquitoes) that transmit heartworm disease as well as a large unregulated coyote population which acts as a reservoir, all dogs, even native dogs who do not leave town and inside dogs who only go out for bathroom breaks, are recommended to be on preventative year round. Which preventative to use will be decided by your veterinarian based on your dog's risk factors, lifestyle and travel arrangements.
All dogs over the age of 6 months will need to be tested for heartworm before starting preventative. Products like Heartgard® Plus work by killing any microfilariae that may enter the bloodstream from a mosquito bite. Because preventatives kill microfilariae it is important to know if the dog has an adult heartworm load before beginning monthly preventatives due to the risk of side effects and the potential for false negative microfilariae tests.
Heartworm preventive medication is labeled by the FDA as veterinary only products to be used under the direction of a licensed veterinarian, therefore requires an active doctor-client-patient relationship and current prescription. Orange Grove Animal Hospital in accordance with state and federal laws and regulations requires us to have examined your pet within a year of the prescription and heartworm testing on the schedule recommended by your veterinarian.
For more information on Heartworm Disease visit the American Heartworm Society.
How to Brush Your Pet's Teeth
Pets are an important part of our lives for many years. As such, dental care is important to extend your pet's good health and quality years with you. Dental disease is the most common problem seen in our pet population today. More than 85% of all dogs and cats presented to veterinarians are affected by dental problems. Periodontal disease is what causes bad breath as well as eventual tooth loss.
We recommend daily dental care at home for your pets, just like the rest of the family. It is best to begin home care at an early age (8 to 12 weeks) during puppy or kittenhood, but it is never too late. Visible tartar should be removed ultrasonically in a process known as scaling and polishing, just like when people go to the dentist. This makes your home care efforts easier and more effective. Always remember to make it fun!
- Washcloth or toothbrush
- Pet toothpaste (see products available in our hospital). Do not use human toothpaste as many contain artificial sweeteners that are toxic to pets.
Week 1 – Slowly Acquainting Your Pet with Mouth Care
Using your hand, gently open the pet's mouth and run your finger around his or her lips, lifting the lips, etc. This should being for just 30 seconds on day one and progressing to a couple of minutes by the end of the week. Reward your pet with a small treat at the end of each session (no "people food" please).
Week 2 – Introducing Toothbrush or Washcloth (Without Toothpaste)
This week, use either a wet washcloth wrapped around your index finger or wet toothbrush on the teeth. Lift lips. Massage the outer surfaces only of upper and lower teeth using a back and forth motion. Do this for 30 seconds on day one, progressing up to three minutes by the end of the week.
Week 3 – Add Toothpaste, Extend Brushing Time
This week use your dental cleaning instrument and now add ¾ of an inch of toothpaste to brush the outer surfaces only of the upper and lower teeth in a back-and-forth motion.
A Few Pointers:
- Do not rush the process or else the pet may become resistant.
- Always treat at the end of each session, making it enjoyable, PRAISE HIGHLY!
- If your pet shows any indication of aggression (growling, bearing teeth, biting, scratching, etc.) stop immediately. Call the hospital for professional advice.
- NEVER use a human toothpaste. Vomiting is common if this is done and newer toothpastes often contain xylitol or saccharin which are toxic to dogs and cats.
- Cleaning at home will reduce the frequency of professional care needed.
- Won't a Milkbone a day take care of it? NO! If you ate a Milkbone a day would you never have to brush your teeth? Of course you would still need to brush. Milkbones help, but they cannot do it alone. Our hospital offers a rawhide chew with an enzymatic coating which helps breakdown calculus but still does not replace the need for professional care.
Based upon the latest information from studies in immunology, we follow the most current recommendations for vaccine protocols for dogs and cats. Many leading researchers and specialists now believe that several of the vaccines that we routinely give to dogs and cats have a greater duration of immunity than had previously been thought. The duration of immunity is the length of time that a vaccine provides protection. In addition to this, some research is suggesting that over-vaccination of pets has led to some problems such as auto-immune hemolytic anemia in dogs and vaccine-associated sarcomas in cats. Although the vaccine manufacturers have not changed their labeling of these vaccines and still recommend vaccinating according to older protocols, many of the foremost veterinary colleges, as well as the American Veterinary Medical Association, the American Animal Hospital Association, the American Association of Feline Practitioners, and other leaders in veterinary medicine research now recommend new vaccine protocols. We are following these guidelines.
Vaccines for Dogs
- The Distemper virus combination and the Parvovirus vaccine (known as the DA2PP) have been shown to have a duration of immunity of multiple years. As a puppy, your dog will receive three sets of vaccinations for these viruses in accordance with current knowledge of developing immune systems. These combination vaccines will protect against: Canine Distemper, Adenovirus-2 (Canine Hepatitis), Parainfluenza, and Parvovirus. Your dog will be required to receive a booster for all of these at one year of age. After the one-year booster, we will begin staggering these vaccines. Your dog will receive the Canine Distemper, Adenovirus 2 and Parainfluenza vaccine one year, the Parvovirus vaccine the next year, and the Rabies vaccine in the third year.
- The Rabies vaccine schedule is government regulated and will not change. We will give the first vaccine after 12 weeks of age. A booster vaccination will be given in one year and then revaccination will occur every three years after that.
- The Bordetella vaccination, commonly referred to as the Kennel Cough vaccine, has been shown to have a duration of immunity of less than one year. Due to this, we will require that all boarding dogs be vaccinated for Bordetella every 6 months. We would also strongly recommend that any dog that goes to grooming facilities, dog parks, dog training, or routinely comes in contact with other dogs be vaccinated for Bordetella. The Bordetella vaccine does not prevent many of the viruses associated with contagious upper respiratory infection in dogs, only against the organism Bordetella Bronchiseptica.
- The Leptospirosis and Corona virus vaccines, though available at our hospital by special order for those canines who are at risk, is not part of our core vaccination protocol. Arizona is a low risk area for these diseases and both these vaccines have a high rate of complications and reactions. If your dog is traveling to an area where these diseases are present or will be participating in activities which may increase the risk of exposure, please speak to your veterinarian about these vaccines.
- The Rattlesnake vaccine is not recommended. It is made from the venom of one of the 11 species of rattlesnake seen in the greater Tucson area, the Western Diamondback Rattlesnake. There has been very little peer-reviewed research on this vaccines safety, effectiveness or duration of protection. "Protective" titers are short lived and require frequent boosters. According to the manufacturer, there are no pending studies or plans for studies on their product. The vaccine does not protect your dog from being bit or change any of the treatment protocol for snake envenomation. Administration of antivenin is still the standard of treatment regardless if this vaccine has been used. For these reasons, our veterinarians do not recommend it and have no plans to offer it in the future.
Vaccines for Cats
- The Feline Rhinotracheitis, Calicivirus, and Panleukopenia vaccine (or RCP) will be given to kittens in a series of two to three vaccinations in accordance with the current knowledge of developing immune systems. After one year, your cat will receive a booster vaccination and then be revaccinated every three years. This vaccine is recommended for all cats, including those who are indoor only and have no to little risk of exposure and is required for boarding in our facilities.
- The Rabies vaccine that we are giving to our feline patients is a recombinant, non-adjuvanted vaccine. There is some evidence to suggest that this vaccine decreases the incidence of rabies vaccine reactions (including vaccine-associated sarcomas) in cats. Currently this vaccine is only rated for one year and will need to be boostered at your cat's annual exam. We strongly recommend this vaccine for all cats, not just outdoor, indoor/outdoor, those cats who live in a house with an indoor/outdoor cat and those cats with a history of aggression towards other cats or humans.
- The recommendations for the Feline Leukemia vaccine have not changed. The initial vaccination will require a series of two injections. Revaccination will then be required on an annual basis. The Feline Leukemia vaccine is recommended for cats that are outdoors or indoor/outdoors and cats that live in multiple cat households with other cats who go outside.
There are other non-core vaccines available for both dogs and cats that we do not routinely recommend for a variety of reasons. Some of the available vaccinations are for diseases not found in Arizona or the vaccination may have conflicting or low efficacy rates or high rates of severe or life-threatening reactions. If you have questions about any other vaccines, please ask our veterinarians about them. Please keep in mind that our vaccination protocol is considered extra-label usage and is not the protocol for which the vaccines have been licensed. However, it is based upon the latest and best veterinary immunological research that is available. We will continue to routinely reevaluate our vaccine recommendations and make any changes to our protocol that is necessary to provide the best care and protection for your pet.
It is still important that your pet receive yearly or twice-yearly veterinary examinations even on a rotating or staggered vaccine schedule. Our pets age much quicker than we do and only your veterinarian can detect the subtle signs of disease.
Your pet has been diagnosed with Valley Fever or your veterinarian is suspicious that your pet‘s symptoms are caused by Valley Fever. Naturally you have a lot of questions and may be confused by the volume of information given by the veterinary staff. You may also be bombarded with myths and facts from friends, family, co-workers and the internet. The purpose of this handout is to give you, the owner, a basic understanding of the disease, what causes it, treatment and monitoring.
What is Valley Fever?
Valley Fever (coccidioidomycosis) is caused by a fungus that grows in our soil about 12-18 inches down. Coccidioides (or Cocci, for short), likes warm and dry climates such as those found in southern and central Arizona, Southern California and southwestern New Mexico. When it rains, the fungus multiplies then enters a dormant state when the moisture level drops. Spores from the fungus are thrown into the air by construction, farming, digging, extensive yard work, etc and then travel on the wind. These spores are then inhaled by your pet.
Once in the lungs, the fungal spores have their ideal environment for reproduction, warm and moist. The spores then begin to multiply and spread through the blood stream attaching themselves to nearly any organ or system. About 3 weeks after infection, the first symptoms may appear. For many pets, these symptoms are brief and self-limiting as the body's immune system deals with the invader. For other pets, "clinical" Valley Fever occurs. The immune system just can't handle the fungal load and more severe symptoms develop.
What systems can be infected? What are the symptoms?
The most common site of infection is the lungs. Since this is the first place the spores settle, many pets have what is called Primary Pulmonary Valley Fever. If the spores settle in another system or the primary form is not treated the pet can develop Disseminated Valley Fever. Sites of infection of Disseminated Valley Fever include the long bones of the front or rear legs, the bones of the spine, the central nervous system (brain and spinal cord), the eyes, the skin or in rare cases, internal organs (liver, kidneys, heart, etc).
The symptoms of Primary Pulmonary Valley Fever include cough (often described as dry and non-productive), decreased appetite, lethargy (tiredness), fever and weight loss. Some pets may develop a severe pneumonia if more than one lobe of the lungs is affected. Symptoms of Disseminated Valley Fever include the symptoms of Primary Pulmonary with or without the cough as well as any of the following: Lameness of or swelling on one or more legs, back or neck pain, seizures, ataxia (stumbling or seeming dizzy), skin abscesses that don't heal with traditional antibiotics, eye cloudiness or pain and/or abdominal pain. Sometimes the symptoms may be vague or mimic other diseases or even injuries.
How is it diagnosed?
Valley Fever is diagnosed using a combination of tests. Blood work and radiographs (x-rays) are the usual starting point. The radiographs will give us a visual picture of the infected system. For example, if your pet is limping, the x-ray will let us see how much of the bone is affected, how large the lesion is and which bone or joint is infected. If your pet has a cough, we can see how much of the lungs are affected and sometimes if the infection is spreading to the bones of the chest. The blood work gives us a wide amount of information. A CBC (complete blood cell count) will let us know if the immune system is responding to the invader, how well it is responding and if we have a concurrent problem, like Tick Fever or anemia to contend with. A blood chemistry will let us know how well the major organ systems like the kidneys, liver and pancreas are working as well as electrolyte values. The last part of the blood work is known as the "Cocci titer". This not only tells us if your pet is positive for Valley Fever infection, but tells us the severity of infection and gives us a way to measure effectiveness of treatment.
What is a titer?
A titer is done by diluting the blood repeatedly and recording positive test results. Titers start at 1:2 (1 part blood, 2 parts dilution) and can go as high as required. Cocci titers are generally reported up to 1:256 (1 part blood, 256 parts dilutant). If at 1:256 your pet's blood is still positive it is reported as "greater than 1:256". The goal is to reduce the titer to "less than 1:2" or negative and have no symptoms.
Unfortunately, the incubation period for Valley Fever is about 3 weeks. This means your pet may have all the symptoms of either Pulmonary or Disseminated Valley Fever, yet the first titer sent out may come back negative. Your veterinarian will want to repeat the Cocci Titer if traditional antibiotic therapy is not eliminating symptoms.
In some cases, the pet will have a low or negative titer, yet have more severe symptoms than expected. This is often due to the pet’s immune system not responding as expected to the invader. If this is the case with your pet, your veterinarian will discuss with you a treatment plan specific for your pet.
How do we treat Valley Fever? And how does the medication work?
Valley fever is treated with a group of drugs called "antifungals" or "fungistatics". Unlike antibiotics we are familiar with, these drugs do not kill the fungal spore instead they slow or prevent the spores from reproducing or multiplying. By preventing reproduction, the medication allows the immune system to take care of the older spores. There are currently three oral forms of antifungals approved for veterinary use. Fluconazole (Diflucan) is the most commonly used as it has the lowest incidence of side effects. Ketoconazole and itraconazole are older medications that are sometimes used in pets who do not tolerate or are not responding to fluconazole. These two medications have a higher incidence of side effects and different monitoring requirements than fluconazole. If oral medications are not providing the treatment response expected, you and your pet may be referred to the Valley Fever specialist, Dr Lisa Shubitz at Veterinary Specialty Center of Tucson.
All these medications are given in weight specific doses. The staff of Orange Grove Animal Hospital works with a number of compounding pharmacies in order to ensure the best price for your medication. If you have a pharmacy preference, please let us know.
What monitoring does my pet need?
For all pets, the current monitoring guidelines are:
Every 3-6 months:
- Recheck Cocci Titer. This involves a simple blood sample taken by the Orange Grove Animal Hospital technicians and sent to our outside lab. Results usually come back to the clinic within 3-5 days.
- Repeat x-rays. If your pet has a bone or spinal lesion, you veterinarian may want to check the x-rays to see if the lesion is decreasing in size. Also if your pet had pneumonia your veterinarian will want to repeat the x-rays to ensure the lungs are healing.
When the lab results come back, this is when your refill for medication will be called into the pharmacy. If your pet has gained weight, the dose may increase at this time.
If your pet is older, is on other medications or has other diseases or conditions that are being treated, your veterinarian may recommend more extensive monitoring. Because fluconazole is mainly eliminated by the kidneys, your veterinarian may recommend monitoring kidney values, especially if your pet has diabetes or decrease kidney function. If your pet is on ketoconazole, itraconazole or a non-steroidal anti-inflammatory (Rimadyl, Metacam, DeraMaxx, etc), has decreased liver function or is older, your veterinarian may want to monitor liver enzyme values along with the kidney values.
What are the side effects of the medication?
Thankfully, fluconazole has fewer side effects than the older drugs like ketoconazole and itraconazole. A few pets may experience gastro-intestinal side effects such as nausea, vomiting, loss of appetite, diarrhea, or abdominal discomfort caused by GI upset (hunched up, reluctance to move or stretch, abdominal tenderness, restlessness). Giving the medication on a full stomach reduces the incidence of these symptoms. With ketoconazole, lightening of the coat color has also been seen. Itraconazole has been known to cause skin ulcerations.
If you notice side-effects or your pet is not tolerating the medication, please let us know.
Can I stop the medication if the symptoms go away?
No! Even if your pet no longer has a cough or limp and seems back to normal, stopping or decreasing the medication without veterinarian approval can only increase length of treatment. In many cases, symptoms return fairly quickly with increased severity. Stopping or decreasing the medication can also cause Pulmonary Valley Fever to worsen to the Disseminated form.
How long will my pet have to take the medication?
That is very hard to predict. Each pet is different with different levels of disease and different immune responses. Length of treatment will depend on many factors: how high the initial titer is, the severity of clinical symptoms, the response to medication (how fast the titer goes down and symptoms resolve), if there is another concurrent disease such as Tick Fever or age-related conditions, how quickly treatment was started after symptoms appeared and of course, dedication of the owner. You will play a big role in determining the success of your pet’s treatment. It is important that you don’t skip or miss doses of medication, have your pet’s blood work checked on time (one to two weeks before finishing current prescription), and provide good nutritional support. Having said that, there are those pets that have to be on medication for life. Your veterinarian will discuss this possibility with you.
What else can I do for my pet?
Nutritional support is very important during any illness. We recommend feeding a high quality food such as Science Diet, Royal Canin, Eukanuba, or Nutro. If your pet has lost a lot of weight or is slightly underweight, we may recommend returning to a high-quality puppy food for the initial few months of treatment. If your pet has stopped eating, we may recommend trying canned food that can be heated to encourage appetite. Occasionally, in very sick pets, we recommend feeding whatever your pet will eat, then switching over to a high-quality food once normal appetite has been established. In rare cases, we will go over detailed instructions on how to force feed your pet and which food to use. You can ask your veterinarian for recommendations regarding nutritional supplements.
Is Valley Fever contagious?
No! Valley Fever is contracted by the inhalation of the fungal spores. Your pet coughing is not spreading spores to you, your other pets or children. There is only one form of Valley Fever that carries a very tiny risk of contagion and thankfully it is very rare (your veterinarian can discuss this form with you). The reason we see some households with more than one pet with Valley Fever is that all the pets in the house have the same risk of infection.
My pet's titer is negative, can he have a relapse? Why?
Yes. According to the University of Arizona Valley Fever Center for Excellence, the relapse rate for people is between 30-50%. As of this time, there hasn’t been a study to find out the exact percentage for pets, but it is suspected to be about the same as it is for people. The causes for relapse are varied and not well understood. If your pet has a return of symptoms or new symptoms, even after having a negative titer for months or years, see your veterinarian as soon as possible.
Where can I get more information on Valley Fever?
The best place to start is the University of Arizona’s Valley Fever Center for Excellence. Your veterinarian can also direct you to other reliable places for information. Remember to take any information gathered from a non-university or non-veterinary source with a huge grain of salt.
As always, the staff at Orange Grove Animal Hospital is here to offer support and information during the course of your pet’s treatment. You are welcome to call with questions at any time during business hours. A technician will return your call as soon as possible and will be happy to answer your questions.
For topics not covered here, please visit Veterinary Partner, a pet owner information website authored by the veterinarians of the Veterinary Information Network.